Provider Demographics
NPI:1720026883
Name:BURACK, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:BURACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5972
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 5C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-7999
Practice Address - Fax:313-966-6400
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-03-27
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Provider Licenses
StateLicense IDTaxonomies
MI4301035219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630024Medicare PIN